Earlier this year, the Senate passed the Inflation Reduction Act (a.k.a. Build Back Better Act) which was heavily covered in press. I will only focus on what the Act has in store for pharmacies and will highlight the most important provisions for the pharmacy industry.

The Act – at its core – gives CMS ability to negotiate drug prices for Medicare and Medicaid plans. By 2026, CMS will directly negotiate prices for selected drugs (initially the 10 most expensive drugs ). CMS does not anticipate that these new prices will result in lower pharmacy reimbursements.


But most importantly for pharmacies, the legislation provided for:

  • a $35 out-of-pocket cap for insulin for Medicare beneficiaries (starting in 2023);
  • a $2,000 cap for Part D out-of-pocket expenses (starting in 2025);
  • free vaccines for Medicare beneficiaries (beginning in January 2023).

Further reading: “Understanding Health Care Provisions in the Inflation Reduction Act,” Kaiser Family Foundation.